Provider Demographics
NPI:1346525342
Name:ATKINS, GORDON (PHARMD)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:
Last Name:ATKINS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18043 MARQUIS RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:VA
Mailing Address - Zip Code:22960-3376
Mailing Address - Country:US
Mailing Address - Phone:540-854-2272
Mailing Address - Fax:
Practice Address - Street 1:309 SOUTHGATE SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-3835
Practice Address - Country:US
Practice Address - Phone:540-825-5335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-21
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202204256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist